Archive for the ‘dumb ideas’ Category

There is an undergraduate research assistant doing research-for-credit for a friend of mine. The research assistant asked me about research on averting mania by changing your emotional coping style. This is the email I drafted after he didn’t like what I sent him (on cognitive-behavioral therapy helping to recognize impending mania and avoid triggers), in response to his explaining to me that actually he was looking for information more relevant to his theory, and that he’d developed the theory because of his ex-girlfriend and her family.

The actual email I sent was kinder than this, but I like this one better. (If anyone thinks any of post would be useful in explaining mental illness stuff to someone else, take all you like; I release this email into the wild for the purposes of education. Take/rephrase/whatever.)

Hi [undergraduate research assistant’s name],

I sent you the most relevant information I’m aware of. I try to stay pretty on top of things, so although it may not be ideal, it’s unlikely there’s anything more related. There’s a reason for that:

We all have intuitions about how peoples’ emotions work, and those tend to work pretty well most of the time, when we’re thinking about most people. So it’s completely accurate that dealing with stress helps (most) people manage emotions quite well. Unfortunately, because people with bipolar disorder have emotion regulation systems that are broken, our intuitions give us faulty predictions about what will fix their problems.

To make an overly simplified analogy, practice well help most people learn to ride a bike – but practice just won’t do it for someone with a missing leg, because they do not have the standard physical setup that people with two legs have. They need a different kind of support before practice will make any difference. A prosthetic leg will let practice come into play, and the prosthetic leg plus practice will let that person bike – but practice alone won’t cut it.

There are definitely therapeutic interventions that help people with bipolar disorder when they are well – and they are very important in helping avoid triggers (like lack of sleep, etc.) that can bring on mood episodes. And cognitive therapy also makes a big difference in training people to recognize when they’re in the early stages of a mood episode so they can seek help before it gets too bad.

People have tried, and continue to try, unsuccessfully, to use *just* therapy (or yoga, meditation, fish oil, supplements, etc) to manage bipolar disorder, instead of using medication. Everyone I know who has bipolar disorder would love to find something that would work without the side effects and stigma of taking medication! As would many mental health practitioners, social workers, etc, who could do a lot of good work by successfully treating a devastating illness.

Unfortunately, no one has come up with a way to do so, despite many of the best minds in research and practice have doing their best for years (you may want to consider that very smart people with years of accumulated knowledge of bipolar disorder have been working on the problem for decades; it has not proved amenable to simple answers, despite many hopes and bold theories).

No reputable mental health provider would consider attempting to treat someone with bipolar disorder entirely without medication, unless they are considering ECT as a last-ditch resort following many medication trials. It is dangerous and unethical to do so because of the consequences that are much more likely to follow off medication than on (consequences like death, debt, ruined relationships, property damage, jail sentences, sexually transmitted diseases, and kindling leading to worsened future episodes, to name a few).

I realize you didn’t say this, but it’s a dangerous idea that a lot of people fall into and I want you to understand this very clearly: It is similarly dangerous and ignorant for friends, family members, etc., to encourage people to go off their medication in favor of alternative treatments. It would be hubris to for a layperson to think they know more than people with years of medical and/or research training and extensive knowledge of what treatment is effective and what is not – unless (until) they have had extensive training in the same.

It can be easy to think you can solve a difficult problem like bipolar disorder with undergrad psych classes and a good idea, but trust me that if that were the case it would have been solved by another brilliant young psych undergrad long before you (as would many, many other problems that we’re still stuck with). Teachers give you the simplified versions of reality in undergrad because no one can learn the difficult complicated crap without first learning the building blocks – but the building blocks aren’t the answer to the real-world problems, they’re just the foundation for starting to understand what the real-world problems actually are.

We do know that there are therapeutic techniques that are indispensable parts of treatment for bipolar disorder, even if they cannot be the only treatment. It’s an important area, and there’s certainly room for some research first on whether coping style really is related to bipolar disorder (it could be that the people you’ve spoken with just happen to have both) and second on whether it provides a useful adjunct to medication (which it may or may not; you do research on techniques to find out whether they work or do not work, not to prove that they do work).

If you would like to learn more about the real-world problem and the scope of its complexity, I recommend:

“Manic-Depression: Bipolar Disorder and Recurrent Depression” (I think that’s the title) by Goodwin and Jamison (the SECOND edition, which just came out; the first is over ten years old). This is really expensive so you probably want to get it through ILL, but it is the absolute definitive work, it is very current, and it is fantastic.